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Tuberculosis

 

Tuberculosis Introduction

Tuberculosis (TB) is an infectious disease caused by the bacteria Mycobacterium tuberculosis. Although it usually attacks the lungs, it can attack any part of the body and have lasting effects after the infection has been stopped. Tuberculosis disease was once the leading cause of death in the United States and is still considered a highly dangerous and infectious condition. Today, reported cases of TB are rare in the United States. The contagious nature of this disease, however, still represents a legitimate concern in modern medicine. Tuberculosis has also been known as phthisis and/or consumption; first being recognized in Greek medical literature. [1]

Tuberculosis has long been prevalent among elderly people. In 1900, many people had a latent, or in a sense, ‘hibernating’ form of the infection, which seemed to transition into the disease later in life. In order to break this cycle and protect future generations from becoming infected, patients were isolated and treated in hospitals and specialized quarantined facilities known as sanitariums. In the 1940s, scientists discovered the first of several drugs now used to treat Tuberculosis. Gradually, many children entered adulthood without being infected. As a result, Tuberculosis slowly began to disappear in the United States. However, between the years of 1985 and 1992, the number of Tuberculosis cases began to increase; promoting medical attention to renew again. Because of this transient scare, funding for Tuberculosis surveillance and treatment programs has been increased. Subsequently, cases are once again on the decline. [2]

Tuberculosis is spread through the air from person to person. When an infected individual coughs or sneezes, the bacteria travels through the air. If another person is within a close vicinity, this individual may breathe it in and become infected. During the initial contraction of the disease, the bacteria settles in the lung and begins to multiply, potentially traveling through the blood stream to other sites in the body, such as the kidneys, brain and spine. Tuberculosis infections that take root in the lung or throat can be passed on. However, if the infection is located in other parts of the body, TB is usually not infectious as it has no direct mechanism to spread from these locations.

Tuberculosis is classed as a granulomatous inflammatory condition, due to tubercles, or the aggregation of white blood cells evident to the naked eye. This is a common pathologic finding in those with Tuberculosis. Tubercles represent a “walling off” of the bacteria, which can sometimes kill the bacteria. Although in other circumstances, the tubercles may grow and cause the destruction of localized tissue. Potentially, the bacteria can gain entry to the blood stream through destroyed tissues and travel to distant sites, setting up multiple focal sites. This is called miliary Tuberculosis, and has a high rate of death.

Depending on one’s resilience, exposure to Tuberculosis doesn’t always mean that symptoms will manifest. Many times the body is able to halt the growth of the bacteria; walling off the infection and causing it to become inactive, and leaving it to exist in a latent state. Those with latent Tuberculosis are typically not symptomatic. These persons are unable to spread the disease as readily as those with an active infection, and may take certain measures to prevent further manifestation of the disease. Many people never experience a full-blown manifestation of Tuberculosis and remain a latent carrier for life. There is a chance, however, that the infection can become active at a later time. Activation depends on multiple factors, including a weakened immune system and surrounding environment. Typically, only around 10% of those infected will display outward signs of infection. Although within this 10%, lies an estimated 50% mortality rate. [3]

Tuberculosis Symptoms

The outward manifestation of Tuberculosis depends on where the bacteria are growing in the body. If in the lungs, which is the most common area of infection, typical symptoms include:

  • A bad cough, lasting longer than 2 weeks
  • Pain in the chest
  • Coughing up blood or phlegm
  • Other more general symptoms include:
  • Weight loss
  • Loss of appetite
  • Chills and fever
  • Sweating at night

Differences Between Latent Tuberculosis Infection and Tuberculosis Disease: [5]

Latent Tuberculosis Infection Tuberculosis Disease
Have no symptoms/don’t feel sick Symptoms include:
Cannot spread Tuberculosis to others A bad cough that lasts more than 2 weeks
Usually have a positive skin test Pain in the chest
Chest x-ray and sputum test normal Coughing up blood or sputum
Weakness or fatigue
Weight loss
No appetite
Chills
Fever
Sweating at night
May spread Tuberculosis to others
Usually have a positive skin test
May have abnormal chest x-ray, and/or positive sputum smear or culture

Tuberculosis Statistics

  • Tuberculosis bacilli infect a new person in the world every second.
  • About one-third of the world’s population is currently infected with the Tuberculosis bacillus.
  • 5-10% of people who are infected with Tuberculosis bacilli manifest Tuberculosis disease at some time during their life. [6]
  • Number of Tuberculosis cases in the United States: 84,304. (1956)
  • Number of Tuberculosis cases in the United States: 14,874. (2003)
  • Number of Deaths due to Tuberculosis in the United States: 19,707. (1956)
  • Number of Deaths due to Tuberculosis in the United States: 764 (2001). [7]

Tuberculosis Treatment

Latent Tuberculosis

Treatment for latent Tuberculosis is important in preventing the infection’s progression to active Tuberculosis disease. A drug regimen, depending on immune status and other risk factors, is employed and appropriately monitored. Drug therapies are typically comprised of combination antibiotic protocols that may last for several months, to more than a year.

Active Tuberculosis

Active Tuberculosis is has a different treatment regimen. This regimen normally consists of a 4-drug protocol, used to prevent the bacteria from proliferating or becoming resistant to one particular drug. Patients should be monitored monthly, to evaluate adherence to the protocol, liver toxicity, and to also check for the onset of specific signs and symptoms of Tuberculosis. Patients with active Tuberculosis are monitored very closely, often to the point that individual medications for disease treatment are monitored by a public health agency. Public health agencies are vigilant in maintaining infected patients on prescribed treatment plans.

Tuberculosis Prevention

Prevention strategies are very widely employed as the most obvious and cost effective means in ‘treating’ this disease. Prevention and control efforts include three priority strategies:

  1. Identifying and treating all persons who have Tuberculosis disease.
  2. Finding people who may have been in contact with Tuberculosis patients; evaluating these individuals to determine whether they have infection or disease; and finally, if they are infected, by treating them appropriately.
  3. Identifying and testing high-risk groups for infection to determine whether they are candidates for the treatment of a latent infection. [8]

Supplements helpful for Tuberculosis

Vitamin A

Vitamin A is a fat-soluble vitamin that has many roles in the body. It is found in several foods in many different forms. Retinol or pre-formed vitamin A supplies about 2/3 of the dietary intake of vitamin A. [9] In addition, the liver contains the largest stored amount of dietary retinol. Vitamin A is needed for growth and bone development, vision, reproduction processes, cell production and maturation, maintaining proper skin integrity, and most importantly, immune function. For those with Tuberculosis, the immune support that vitamin A provides seems to improve the outcome of drug treatment. Some research shows that there is a tendency for those with Tuberculosis disease to have a deficiency in vitamin A levels. [10]

In a study involving 80 patients with active Tuberculosis who were receiving standard Tuberculosis drugs, supplementation with vitamin A improved the effectiveness of the drug treatment. [11] Those receiving the supplementation were twice as likely to cough up and eliminate the TB bacteria through their sputum compared to those only receiving the standard drug regime. This study also showed a reduction in abnormalities in chest X-ray than the control group. [12] More studies are necessary into the effectiveness of vitamin A supplementation on TB positive individuals. However, the known benefits of vitamin A on the human immune system are reason enough to incorporate this inexpensive adjunctive treatment into combating Tuberculosis.

Beta Sitosterol

Beta Sitosterol is a plant compound similar to cholesterol. Although the average diet provides small amounts, absorption is not very high and thus doesn’t share any of the negative health effects associated with excess cholesterol consumption. Beta Sistosterol actually plays more of a regulating effect, inhibiting cholesterol when consumed in excess and provoking the liver to increase production when cholesterol is in lower amounts. Evidence suggests that beta sitosterol may have immuno-stimulatory effects, and is thus helpful in Tuberculosis disease. Taken with a standard regimen of drugs for Tuberculosis, research shows that there is an increase in white blood cell production, as well as an increase in weight gain in these patients. [13] White blood cell increases in number and mobility are key to fighting infectious processes of any kind.

Vitamin D

Vitamin D is a fat-soluble vitamin that is involved in many processes in the body. Besides its role in building bone mass and preventing bone loss, protecting against muscle weakness, and promoting strong teeth, it also enhances immune function. Because susceptibility to disease partially depends on one’s immune status, low levels of vitamin D may make one more likely to manifest Tuberculosis. Usually, vitamin D metabolism leads to an increased ability of the immune system to restrict intracellular growth of the Tuberculosis bacteria. A study involving Gujarati Asians in west London who tested positive for Tuberculosis showed decreased levels of vitamin D, which investigators suspected might have contributed to the high occurrence level of Tuberculosis in this population. [14]

In a mammalian study investigating the role of vitamin D in Tuberculosis disease, pigs were given vitamin D in their feed then injected six weeks later with the Tuberculosis bacteria. Results showed that in those that were vitamin D deficient, there was an adverse effect on the tuberculin reaction and decreased the ability to control the infection, implying that vitamin D status is influential in Tuberculosis immunity. [15] Similar to vitamin A, supplementation with vitamin D is a highly cost effective adjunctive therapy for Tuberculosis.

Zinc

Zinc is the second most abundant trace mineral in the body. It is a cofactor in many biological processes within the body, including synthesis of RNA and DNA. It participates in wound healing, reproductive processes, taste, smell, hormone production, and many processes involving growth and development. [16] Zinc’s role in immune function is highly important. Studies show that it has a positive influence on Tuberculosis disease.

In the same abovementioned study involving vitamin A, zinc seems to have a positive effect on Tuberculosis disease outcome when combined with a standard drug regimen. The study involved newly diagnosed patients with Tuberculosis; at the conclusion of the study, it was determined that zinc supplementation improved the effectiveness of anti-tuberculosis treatment. [17]

Allium sativum (Garlic)

Garlic is a member of the lily family and is cultivated throughout the world. Its medicinal use dates back many centuries to various parts of the world, including China and Egypt. Is is thought that the volatile oils of Garlic are responsible for its pharmacological effects. In fact, the famous Greek physician Hippocrates prescribed garlic for the treatment of cancer.

As far back as 1944, American studies show the antimicrobial effects of garlic on certain bacteria. [18] Concerning Tuberculosis disease, research suggests that garlic has an inhibitory effect on four different strains of Mycobacterium tuberculosis, the bacteria that causes Tuberculosis disease. [19] Another study discussed the various concentrations of garlic needed to inhibit certain strains of Mycobacterium, reinforcing the role if garlic in Tuberculosis adjunctive treatment. [20]

Standard Tuberculosis treatment can provide much greater efficacy when natural medicines with proven immune-stimulating functions are employed. Additionally, in those with latent Tuberculosis, a protocol using natural medicines may serve to greatly improve patient outcomes.

References

[1] Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[2] Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[3] Online document at: http://en.wikipedia.org/wiki/Tuberculosis

[4] Online document at: ibid

[5] Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[6] Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[7] Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[8] Online document at: http://en.wikipedia.org/wiki/Tuberculosis

[9] Denke MA. Dietary retinol–a double-edged sword. JAMA 2002;287:102-4.

[10] Hanekom WA, Potgieter S, Hughes EJ, Malan H, Kessow G, Hussey GD. Vitamin A status and therapy in childhood pulmonary tuberculosis. J Pediatr. 1997 Dec;131(6):925-7.

[11] Karyadi E, West CE, Schultink W, Nelwan RH, Gross R, Amin Z, Dolmans WM, Schlebusch H, van der Meer JW A double-blind, placebo-controlled study of vitamin A and zinc supplementation in persons with tuberculosis in Indonesia: effects on clinical response and nutritional status. Am J Clin Nutr. 2002 Apr;75(4):720-7. [12] West Clive E., et al, American Journal of Clinical Nutrition (2002;75:720-727)

[13] Donald PR, Lamprecht JH, Freestone M, et al. A randomised placebo-controlled trial of the efficacy of beta-sitosterol and its glucoside as adjuvants in the treatment of pulmonary tuberculosis. Int J Tubercul Lung Dis 1997;1:518-22.

[14] Wilkinson RJ, Llewelyn M, Toossi Z, Patel P, Pasvol G, Lalvani A, Wright D, Latif M, Davidson RN, Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case-control study. Lancet. 2000 Feb 19;355(9204):618-21

[15] McMurray DN, Bartow RA, Mintzer CL, Hernandez-Frontera E. Micronutrient status and immune function in tuberculosis. Ann N Y Acad Sci. 1990;587:59-69.

[16] Barceloux DG. Zinc. J Toxicol Clin Toxicol 1999;37:279-92.

[17] Karyadi E, West CE, Schultink W, Nelwan RH, Gross R, Amin Z, Dolmans WM, Schlebusch H, van der Meer JW A double-blind, placebo-controlled study of vitamin A and zinc supplementation in persons with tuberculosis in Indonesia: effects on clinical response and nutritional status. Am J Clin Nutr. 2002 Apr;75(4):720-7.

[18] Huddleson IF, et al.: Antibacterial substances on plants. J Am Vet Med Assoc 105, 394-397, 1944

[19] Abbruzzese MR, Delaha EC, Garagusi VF. Absence of antimycobacterial synergism between garlic extract and antituberculosis drugs. Diagn Microbiol Infect Dis. 1987 Oct;8(2):79-85.

[20] E C Delaha and V F Garagusi Inhibition of mycobacteria by garlic extract (Allium sativum). Antimicrob Agents Chemother. 1985 April; 27(4): 485–486.